PURPOSE: Management of regional nodes of penile squamous cell carcinoma (SCCp) has changed over time due to improved knowledge about diagnosis and treatment.
In order to determine whether treatment changes of regional nodes have improved survival, we compared contemporary five-year cancer-specific survival (CSS) of SCCp patients with CSS of patients in previous cohorts.
MATERIALS AND METHODS: In an observational cohort study of 1000 patients treated over a period of 56 years, 944 patients were eligible for analysis. Tumors were staged according to the 2009 TNM classification and patients were divided into four cohorts reflecting changes in clinical practice of regional nodes: 1956-1987, 1988-1993, 1994-2000 and 2001-2012. Kaplan-Meier survival curves with the log-rank test and Cox proportional hazards modeling were used to examine trends in five-year CSS.
RESULTS: Five-year CSS of cN0-patients treated between 2001-2012 was 92% against 89% (1994-2000), 78% (1988-1993) and 85% (1956-1987). The five-year CSS has significantly improved since 1994, the year dynamic sentinel node biopsy was introduced: 91% (1994-2012) versus 82% (1956-1993) (p=0.021). This conclusion still holds after adjustment for pathological T-stage and grade of differentiation (HR 2.46, p=0.01). Extranodal extension (ENE), number of tumor-positive nodes and pelvic involvement in node-positive (pN+) patients were associated with worse five-year CSS.
CONCLUSIONS: Despite less surgery on regional nodes, five-year CSS has improved in cN0-patients. Number of tumor-positive nodes, ENE and pelvic involvement are highly associated with worse cancer-specific survival in pN+ patients. In this group other treatment strategies are needed, as no improvement was observed.
Written by:
Djajadiningrat RS, Graafland NM, van Werkhoven E, Meinhardt W, Bex A, van der Poel HG, van Boven HH, Olmos RA, Horenblas S. Are you the author?
Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Reference: J Urol. 2013 Aug 2. pii: S0022-5347(13)05054-4.
doi: 10.1016/j.juro.2013.07.088
PubMed Abstract
PMID: 23917166
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